General practitioners (GPs) play a pivotal role in mental health services, with the ability to identify and manage mental health issues at an early stage and provide ongoing support through long-term doctor-patient relationships. However, there is a disparity in the development of GPs with a special interest in mental health between China and other countries, with domestic practices lagging behind. There is an urgent need to draw on international experience to foster local development. This paper reviews the progress of GPs with a special interest in mental health both domestically and internationally, analyzes the content of primary health care mental health services in different countries, and summarizes the exploration and achievements in the training and practice of GPs in mental health in China. The paper suggests that China needs to increase government support, promote routine screening and early intervention, advocate for multidisciplinary team collaboration, and develop telemedicine and information services. At the same time, it is recommended to formulate mental health service strategies that are suitable for local medical, social, and cultural environments and social cognition, in order to enhance the development level of GPs with a special interest in mental health in China and improve the quality and overall effectiveness of primary mental health services. Future research will focus on evaluating the long-term effects of mental health training for GPs, optimizing multidisciplinary team collaboration models, and studying the application effects of information technology in mental health services.
The expansion of responsibilities in general practice niche in China is still in early stages, facing challenges such as insufficient standardized training and a lack of unified assessment and certification mechanisms. There is no consensus within the industry regarding the necessity, pathways, and models for developing sub-specialty capabilities in general practitioners across management, teaching, and clinical practice.
Taking the expanded role in the international general practice niche as a reference, combined with the domestic model of combining general practice and specialization, this study adopted the Delphi expert consultation method and questionnaire survey method to explore the necessity, main paths, and training methods of cultivating sub-specialty capabilities of general practitioners.
Based on the literature analysis and the previous research results on the development of the integrated general and specialized medical capabilities of community health service centers in Shanghai, we had initially proposed the subspecialty capability item pool for the training of general practitioners. From March to July 2024, we adopted the Delphi expert consultation method, with 60 experts as the research subjects for consultation and argumentation. Through two rounds of consultation, we determined the items regarding the role and necessity of cultivating subspecialty capabilities among general practitioners. At the same time, we surveyed the experts' tendencies regarding the training paths and models, designed the questionnaire dimensions, and the contents included: the training methods for the sub-specialization capabilities of general practitioners, the training time stages, the knowledge and skills categories, the preference for professional direction selection, and the assessment and recognition institutions, etc.
The effective response rates for both rounds of expert consultation questionnaires were 100.0%, with expert authority coefficients of 0.92 and 0.94, and expert coordination coefficients of 0.146 and 0.165, respectively (P<0.001). After two rounds of expert consultation, a set of items regarding the role and necessity of subspecialty competencies for general practitioners were finally formed, consisting of 3 first-level items and 15 second-level items. In terms of the role and necessity of cultivating subspecialty abilities among general practitioners: the mean importance scores for the 3 first-level items (the role of developing subspecialty abilities among general practitioners in primary healthcare; the coordination and complementarity between general medical basic work and specialized disease/subspecialty work; the necessity of developing subspecialty competencies for general practitioners) were all between 4.90 and 4.93, with full-score rates ranging from 88.3% to 91.7%, and coefficients of variation ranging from 0.05 to 0.06; the mean importance scores for the 15 second-level items were all between 4.42 and 4.98, with full-score rates ranging from 45.0% to 98.3%, and coefficients of variation ranging from 0.03 to 0.13. In terms of the pathways and modes for developing subspecialty competencies for general practitioners: 96.7% (58/60) of the experts chose specialist training in tertiary medical institutions with training qualifications for general practitioners, 93.3% (56/60) chose apprenticeship training (supervised by experts from tertiary medical institutions with training qualifications); 78.3% (47/60) of the experts chose the stage of attending physician title, and 11.7% (7/60) chose the stage of resident work after standardized training as the timing for entering subspecialty training.
The cultivation of expanded responsibilities in general practice niche is a practical logic that must be promoted for the development of primary healthcare. It is advisable to establish the "attending physician stage" as the starting point for the development of niche, and adopt the current strategy of "advanced training in tertiary hospitals combined with a mentorship system". Prioritize the development of subspecialties in dermatology and rehabilitation, and focus on stimulating and cultivating niche outside of hospital departments.
The actual capacity of community health service institutions in Shanghai for the diagnosis and treatment of depressive disorders has not been systematically evaluated, and there is a lack of empirical research on the urban-suburban differences.
To assess the current capacity of community health service institutions in Shanghai in the screening, diagnosis, treatment and management of depressive disorders, investigate the knowledge mastery and practical difficulties of community general practitioners, focus on analyzing urban-suburban differences, and provide evidence for optimizing the primary mental health service system.
A cross-sectional questionnaire survey was conducted among 244 community health service centers across 16 administrative districts in Shanghai from July to August 2025. A total of 2 222 valid questionnaires were collected from institutional managers and general practitioners (244 and 1 978 questionnaires from institutions and doctors, respectively). The institutional survey mainly covered: screening tools for depressive disorders, relevant laboratory/examination items, drug allocation, psychotherapy, related management, and the establishment of specialized clinics in medical institutions. The survey for community general practitioners mainly focused on: knowledge of diagnosis and treatment of depressive disorders, cognition of screening tools for depressive disorders, cognition of differential diagnosis between depressive disorders and bipolar disorder, cognition of follow-up for depressive disorders, and difficulties in the diagnosis, treatment and management of depressive disorders.
Among the 244 community health service institutions in 16 districts of Shanghai, 80 (32.8%) and 164 (67.2%) subjects were urban and suburban institutions, respectively; among 1 978 general practitioners, 505 (25.5%) and 1 473 (74.5%) subjects were urban and suburban practitioners, respectively. Regarding screening tools for depressive disorders, the allocation rate of Self-rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) in urban institutions was 47.5%, 43.8% and 12.5%, respectively, compared with 44.5%, 38.4% and 7.3% in suburban institutions. In terms of examinations, the availability rate of electroencephalography and echocardiography in urban and suburban community health service centers was 17.5% vs 4.3% and 70.0% vs 51.8%, respectively; the proportion of electroencephalography and echocardiography was higher in urban areas than in suburban areas (P<0.05). In terms of therapeutic drugs, the allocation rate of benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) in urban and suburban community health service centers was 95.0% vs 91.5% and 38.8% vs 33.5%, respectively. In terms of specialized clinics, the availability rates of psychosomatic disease clinics and psychological counseling clinics in urban and suburban community health service centers were 17.5% vs 4.3% and 15.0% vs 28.0%, respectively; the rate of psychosomatic disease clinics was higher in urban areas, while the rate of psychological counseling clinics was lower in urban centers than in suburban centers (P<0.05). The main difficulties in the management of depressive disorders in community health service centers included: limited medical resources, limited dedicated managerial staff and time (95.1%), lack of therapeutic drugs and psychotherapy skills (87.7%), and poor patient compliance with distrust in community medical staff (60.2%). The awareness rate of the diagnostic duration of depressive symptoms (minimum duration of depressive symptoms for diagnostic significance) among urban and suburban general practitioners was 52.3% and 57.6%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rates of PHQ-9 and SDS among urban and suburban general practitioners were 64.0% vs 57.8% and 65.9% vs 59.5% respectively, indicating the urban community general practitioners were higher than the suburban community general practitioners (P<0.05). The awareness rates of decreased sleep need, distractibility and inflated self-esteem were 61.2% vs 67.3%, 41.2% vs 49.6% and 57.2% vs 64.3%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rate of monthly follow-up was 73.9% in urban areas and 82.1% in suburban areas, indicating that the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The suburban general practitioners reported the higher rates of difficulties in diagnosis and treatment (including insufficient suicide risk assessment ability, insufficient non-pharmacological treatment ability and insufficient post-treatment efficacy evaluation ability) than the urban general practitioners (P<0.05). In management difficulties, suburban practitioners also reported the higher rates of insufficient health education capacity on depressive disorders, lack of expert guidance in communities, and lack of two-way referral channels with higher-level hospitals (P<0.05).
Community health service institutions in Shanghai, especially those in suburban areas, should strengthen the allocation of screening tools, relevant examinations and medications. It is necessary to improve general practitioners' mastery of depressive disorder knowledge, health education ability and psychotherapy skills. Institutional construction, resource allocation and capacity improvement should be strengthened to promote an integrated management system and enhance the efficiency of primary mental health services.
Under the background of the global transformation of primary health care (PHC) systems, the patient-centered medical home (PCMH) model, with its core philosophy of "people-centered, integrated, continuous, and team-based care", has emerged as a significant paradigm for enhancing PHC service quality. In China, community health services are undergoing a critical transition from a disease-treatment focus towards health management. The deepening implementation of systems such as contracted family doctor services and hierarchical diagnosis and treatment provides fertile ground for adopting and integrating PCMH concepts. This paper systematically reviews the core elements of PCMH and international practical experiences. By comparing these with the current state of China's community health service system, it identifies structural discrepancies and transformational challenges across six key dimensions: payment incentives, information technology, human resources, service culture, organizational management, and systemic collaboration. Corresponding synergistic reform strategies are proposed. Building on this analysis, the study constructs a progressive, four-stage implementation pathway comprising "organizational preparation, process re-engineering, comprehensive scaling, and continuous improvement". The aim is to provide a reference that combines theoretical systematicity and practical operability, thereby to promote the high-quality development of China's contracted family doctor services with the emphasis shifting from "quantity of contracts" to "quality of service", and from "fragmented" to "integrated" care.
Primary health institutions serve as the frontline defense against hypertension and diabetes. Their capabilities are critical to China's ability to effectively prevent and control these two chronic conditions.
To analyze the current situation of health management and treatment services provided by community hospitals in China for patients with hypertension and diabetes to identify problems and make suggestions.
The "Quality Service Grassroots Activities Application System" collected information on hypertension and diabetes prevention and treatment capacity and service provision in 3 718 community hospitals. Descriptive statistical analysis and multiple linear regression analysis were carried out based on Stata15.0.
There were statistically significant differences in the allocation of electrocardiogram machines and peripheral blood glucose meters among primary health institutions across different regions (P<0.001). Similarly, significant regional disparities were observed in the availability of essential antihypertensive and hypoglycemic medications (P<0.001). The annual number of hypertension and diabetes diagnoses and treatments per institution also varied significantly by region (P<0.001). Additionally, significant differences were found in the renewal rates of hypertensive and diabetic patients across regions(P<0.001). Furthermore, significant variations were observed among regions in the standardized management rates of hypertensive and diabetic patients, as well as in blood pressure and blood glucose control rates (P<0.001). Multiple linear regression analysis revealed that factors such as region, institution type, the number of essential antihypertensive drugs available, the number of registered general practitioners, the proportion of medical income to total income, the proportion of medical insurance income to medical income, and the contract renewal rate significantly influenced the annual number of diagnosed and treated hypertensive patients (P<0.05). Similarly, region, institution type, the number of practicing (assistant) physicians, the proportion of medical income to total income, and the renewal rate were found to affect the standardized management rate of hypertensive patients (P<0.05). Moreover, region, institution type, the number of electrocardiogram machines, the number of practicing (assistant) physicians, and the proportion of medical income to total income had statistically significant effects on blood pressure control.
The hardware conditions of community hospitals in the western region are better, but the medical service capacity is not as good as that in the east, and the soft power still needs to be improved. The ECG machine is the best, but the peripheral blood glucose meter, drug equipment, diagnosis and treatment times and other indicators that reflect the ability of medical services are not as good as those in the east. The integration of medical prevention of hypertension and diabetes still needs to be implemented, and public health indicators such as standardized management rate and blood pressure and blood glucose control rate are "decoupled" from the medical service capacity of community hospitals, and the indicators related to medical services and public health services are "inverted", with the former being high in the east and the latter in the west, and the quality and service connotation of public health data need to be improved.
Community health education is widely recognized as an effective health promotion strategy with low costs and high benefits. Nevertheless, existing research on health education needs lacks an analytical framework based on various community types, making it difficult to fully explain the differentiated and diverse health education needs under the complex population composition of urban communities.
To investigate the health education needs of residents in different types of communities and whether there are significant differences, thereby providing support for community health medical science popularization efforts.
This study was conducted in Hangzhou from April to June 2024, employing a mixed-methods research approach. The qualitative research phase involved purposive sampling to select open-ended interviews from heterogeneous, transformed, homogeneous and system-based community types, aiming to understand residents' perceptions of health education needs. A total of 14 residents were included, along with 21 policy texts to understand the knowledge system residents should possess in health education. Nvivo 12.0 software was utilized to perform a three-level coding of the text data, categorizing health education content needs based on resident perspectives and policy document analysis. Based on the identified themes, a questionnaire was designed. In the quantitative research phase, residents from four community types were selected as survey subjects, and the Likert 5-point scale was used to quantify the needs for health education content. Then, descriptive statistics, nonparametric tests, and multivariate Logistic regression models were employed to investigate the degree of these needs and differences in health education content among different community types.
The qualitative research synthesized eight primary themes of health education: major disease prevention and control, healthy lifestyles, maternal and child health, mental health, environmental health, medication health, emergency and safety, and sex education, encompassing 23 specific educational topics. A total of 299 valid questionnaires were collected in the quantitative research, with a response rate of 94.03%. The results highlighted that the highest need is first aid knowledge [5 (4, 5)], followed by cancer prevention and treatment [4 (4, 5)]. Kruskal-Wallis H test results indicated that residents' educational level, income level, and different types of communities had a significant impact on the health education needs (P<0.05). Further multivariate Logistic regression analysis showed that different educational levels significantly influenced the needs for diabetes prevention (P<0.05) and life safety education, different income levels significantly affected the needs for cardiovascular and cerebrovascular disease prevention and infectious disease prevention (P<0.05), and different types of communities had significant differences in the needs for natural environmental pollution prevention, infectious disease prevention, diabetes prevention, cardiovascular and cerebrovascular disease prevention, first aid knowledge, and life safety education (P<0.05).
Residents' perceptions of community health education needs are diverse, influenced by multiple factors such as educational level, income level, and community health resources. Different types of communities should closely align with residents' perceptions of health education needs for precise targeting, while ensuring the effectiveness and equity of educational resources.
As a unique medical resource in China, traditional Chinese medicine (TCM) has palyed an essential role in maintaining population health. However, facing the growing health demands, some problems of TCM at the grassroots become prominent, such as the unbalanced and inadequate development of TCM and the weak service capacity of TCM. Therefore, it is crutial to improve the rural TCM service system for rural revitalization and the construction of a healthy China.
To evaluate the medical service capacity and efficiency of village clinics in a district of Beijing, analyze the existing problems in the development of TCM, and provide reasonable suggestions for further promoting the development of TCM in village clinics.
A total of 394 village health centres in a district of Beijing were selected for the study from January to March in 2021. First, descriptive statistical analysis was used to analyze the TCM provision capacity of the village clinic in 2019, including TCM related human, material and financial resources and services. Then, data envelopment analysis was employed to calculate the overall efficiency, pure technical efficiency and scale efficiency of the villiage clinic. The human resources and hardware construction were regarded as input indicators, and capital return and service volume as output indicators. The comprehensive efficiency, technical efficiency and scale efficiency of the village clinic were calculated.
Overall, 394 village clinics in this district provided TCM services in 2019. There were 45 rural doctors mainly practicing TCM, 471 sets of TCM diagnosis and treatment equipment. The income of Chinese herbal medicine and Chinese patent medicine was 1.224 5 million yuan and 34.161 9 million yuan, respectively. The number of TCM treatments was 64 716 times. Based on data envelopment analysis, 264 village clinics were in a state of increasing return to scale, 13 village clinics were in a state of decreasing return to scale, and only 7 village clinics were in a state of effective allocation of TCM resources. Besides, there were regional differences in the efficiency of TCM service among townships, towns and streets.
The village clinics in this district have some problems, including inadequate TCM rural doctors, insufficient TCM related equipment, evident disparities in medical income, and low efficiency of TCM service provision. Among them, the problem of scale efficiency is particularly prominent, which has become a key factor restricting the improvement of TCM service efficiency, resulting in the slow development of TCM in the region. These problems might be solved by a series of measures, such as enlarging TCM talents, optimizing the allocation of TCM relaed equipment, improving the health compensation mechanism, and strengthening the distinctive advantages of TCM, and then TCM in village clinics could devlelop with high-quality in the new era.
The "3+2" order-oriented assistant general practitioners in Jiangsu Province play an important role in primary medical care, but face problems such as low fulfillment rates and a lack of professional identity, and urgently need to improve their work-related flow (WOLF).
To investigate the current situation of WOLF of "3+2" order-oriented assistant general practitioners in Jiangsu Province, and to analyze its influencing factors.
An online questionnaire survey of "3+2" order-oriented assistant general practitioners in Jiangsu Province was conducted in November 2024 using random sampling method. The general information of the questionnaire included gender, age, marriage, year of entry into training, assistant practitioner qualification or not, monthly income level, daily sleep hours, weekly work hours, and physical exercise; career calling (CC), career reshaping (CR), and WOLF were scored using relevant scales. Multiple linear regression was used to analyze the influencing factors of WOLF of order-oriented assistant general practitioners.
Of the 299 questionnaires distributed, 282 were valid, resulting in a recovery rate of 94.31%. Among these order-oriented assistant general practitioners, 98 (34.75%) were male and 184 (65.25%) were female, with an average age of (22.5±1.4) years. The Jiangsu order-oriented assistant general practitioners' total CC score was 4.23±0.75, their total CR scale score was (4.32±0.75), and their total WOLF scale score was (5.57±1.40). All of these scores were above the intermediate level of the scale. Male order-oriented assistant general practitioners had higher CC, CR, and WOLF scale scores than females (P<0.05). A comparison of the WOLF scale scores of order-oriented assistant general practitioners according to sex, age, year of admission to training, assistant practitioner qualification, daily sleep hours, and physical activity revealed statistically significant differences (P<0.05). Multiple linear regression analysis revealed that gender, age, assistant medical practitioner qualification, and physical activity influenced order-oriented assistant general practitioners' sense of WOLF (P<0.05), with an adjusted R2 value of 0.104. The CC score significantly positively affected the sense of WOLF (β=0.855, P<0.05), with an adjusted R2 value of 0.735. However, CR had a non-significant effect on WOLF (β=0.038, P>0.05).
The overall level of WOLF among "3+2" order-oriented assistant general practitioners is relatively high, and CC is the core influencing factor that can significantly improve WOLF. To further enhance WOLF, it is recommended that the sense of CC among order-oriented assistant general practitioners be strengthened, that physical exercise be encouraged, that training bases be strengthened, and that the level of monthly income be raised, with a special focus on the career development of female order-oriented assistant general practitioners.
Primary healthcare workers' work motivation is closely related to the quality and accessibility of health services. Autonomous motivation represents a higher-quality form of motivation, yet it is not fixed and may change with factors such as career experience and the institutional context, thereby exerting potential effects on work-related outcomes.
Drawing on Self-determination Theory (SDT), this study compared primary healthcare workers' initial (entry) motivation for practicing medicine with their current work motivation to describe changes in autonomous motivation (i.e., engaging in an activity based on full willingness and autonomous choice) and to examine the reasons for such changes and their associations with key work outcomes.
A mixed-methods design was adopted. Using multistage cluster sampling, we selected three cities in Shandong Province, China (Yantai in the east, Zibo in the central region, and Liaocheng in the west). In each city, three districts/counties were selected, and four primary healthcare institutions were sampled within each district/county, yielding 36 survey sites. On the survey day, all on-duty healthcare workers (including physicians, nurses, public health workers, and medical technicians) were invited to complete a questionnaire. Of 1 271 questionnaires distributed, 1 113 were valid (effective response rate: 87.6%). In addition, 107 participants were purposively sampled for in-depth interviews. Initial motivation for practicing medicine was measured using a self-developed questionnaire, while current work motivation was assessed with a revised Work Motivation Scale. Based on SDT, both initial and current motivations were classified into two types: autonomous motivation and non-autonomous motivation. By comparing the dominant type of initial and current motivation, a "motivation change" variable was constructed, yielding four categories. Four key indicators of work attitudes and behaviors were assessed: turnover intention, job burnout, job satisfaction, and job performance. Questionnaire data were analyzed using descriptive statistics, analysis of variance (ANOVA), and multiple linear regression. Interview data were analyzed using the thematic framework approach.
For initial motivation, 545 (49.0%) participants were classified as having autonomous motivation and 568 (51.0%) as having non-autonomous motivation. For current work motivation, 713 (64.0%) participants had autonomous motivation and 400 (36.0%) had non-autonomous motivation. The 2×2 "motivation change" variable produced four categories: stable autonomous motivation (n=403, 36.2%), stable non-autonomous motivation (n=258, 23.2%), autonomization (n=310, 27.8%), and de-autonomization (n=142, 12.8%). Scores for turnover intention, job burnout, job satisfaction, and job performance differed significantly across the four categories (all P<0.05). Specifically, compared with the stable autonomous motivation group and the autonomization group, the stable non-autonomous motivation group and the de-autonomization group reported higher turnover intention and job burnout (P<0.05) and lower job satisfaction and job performance (P<0.05). In addition, the autonomization group had higher turnover intention and job burnout (P<0.05) and lower job satisfaction and job performance (P<0.05) than the stable autonomous motivation group. Multiple linear regression indicated that, relative to the stable autonomous motivation group, the other three groups had higher regression coefficients in the models for turnover intention and job burnout (P<0.05) and lower regression coefficients in the models for job satisfaction and job performance (P<0.05). Interview findings suggested that changes in motivation were mainly influenced by the needs for meaning, competence, and relatedness.
Autonomous motivation is associated with better work performance among primary healthcare workers. Greater resource investment and institutional improvements are needed to foster a more supportive organizational context—such as strengthening health information systems, improving training mechanisms, and innovating doctor-patient communication-to satisfy primary healthcare workers' basic psychological needs and thereby enhance autonomous motivation.
The trend towards specialization in general hospitals has promoted the development of professional and refined medical technology. However, it also brings problems: patients with complex conditions need to seek medical advice across multiple specialties, increasing the difficulty of accessing healthcare and potentially leading to incomplete treatment plans. Therefore, when dealing with undifferentiated diseases, general practitioners (GPs) must take on the responsibility of providing multidisciplinary comprehensive support.
To analyze GPs' understanding and practice regarding multidisciplinary undifferentiated disease treatment (MUD-MDT).
A survey questionnaire targeting MUD-MDT was developed, and distributed to GPs from multiple hospitals nationwide via the General Practice Alliance platform affiliated with the First Affiliated Hospital of Zhejiang University School of Medicine, collecting basic information of GPs, their awareness and practice of undifferentiated diseases (MUD), and multidisciplinary diagnosis and treatment (MDT).
A total of 303 questionnaires were included, with an average age of (38.8±9.2) years; 194 females (64.03%) and 109 males (35.97%). Regarding MUD, 88.78% (269/303) knew about MUD, but only 23.79% (64/269) had participated in related work; the main reason for lack of knowledge was "lack of relevant training" at 76.47% (26/34). For MDT, 91.42% (277/303) were aware of it, 77.26% (214/277) merely knew the basic concept, and only 22.74% (63/277) had participated in related work. In terms of practical implementation, 32.67% (99/303) had implemented MUD, 49.83% (151/303) had implemented MDT, and 20.46% (62/303) had implemented MUD-MDT. There was a high recognition of MUD-MDT among GPs. Differences in MUD awareness among GPs with different professional titles were statistically significant (P<0.05); differences in MDT awareness between genders and education levels were statistically significant (P<0.05); differences in the implementation of MUD-MDT among different genders, working years, and types of affiliated medical institutions were statistically significant (P<0.05). Analyzing the cognitive scores of three groups of GPs who had implemented, not implemented, or were unclear if MUD-MDT was implemented at their units showed no significant difference in all cognitive items (P>0.05).
Although GPs have a certain level of understanding of MUD-MDT, the implementation rate is not high. Despite its application in outpatient clinics, wards, and teaching activities, more efforts are needed to address issues such as inadequate organizational management, lack of standardized procedures, and uneven professional competence among doctors.
Primary medical first consultation plays an important role in the rational utilization of medical services and alleviating the contradiction between supply and demand of medical resources. However, the rate of primary medical first consultation in China is lower than the policy expectations, and it is very important to guide patients to primary care. Therefore, it is of great significance to conduct an in-depth exploration of the driving mechanism of patients' willingness for primary medical first consultation.
Based on the family doctor contract service scenario, a theoretical model of "expectation confirmation-patient trust-sustained willingness to first visit at the grassroots level" was constructed based on the expectation confirmation theory. Through empirical research, this paper verifies the social psychological mechanism of patients' willingness to continue grassroots first diagnosis, reveals the path of patient trust, and provides theoretical basis and practical enlightenment for improving patients' willingness to continue grassroots first diagnosis.
Taking a community health service center in Chengdu as the research site, a questionnaire survey was conducted on the patients served by the center in March 2024, including four parts: general information questionnaire, expectation confirmation, patient trust, and medical seeking willingness at the grassroots level. Independent sample t-test and one-way analysis of variance were used to study the differences in patients' trust between groups, and the structural equation model was used to verify the theoretical hypothesis and mediating effect.
A total of 318 questionnaires were collected for the survey, of which 288 (90.6%) were valid. The average expection confirmation score for patients was (3.99±0.74) points, with 208 cases (72.2%) exhibiting high expected confirmation. The average patient trust score was (4.13±0.61) points, with the three dimensions of technical trust, service trust, and emotional trust averaging (4.18±0.65), (3.60±1.02), and (4.35±0.64) points respectively. Patients who were adults, aged 60 years or older, had hypertension/diabetes, had signed up with a family doctor, and had high expectations demonstrated higher trust in primary care (P<0.05). Patients who did not have a designated doctor showed lower trust in primary care (P<0.05). Patient trust had a complete mediating effect between expectation confirmation and the willingness to seek initial treatment at primary care facilities (P<0.05).
Patient trust has a significant full mediating effect between expectation confirmation and willingness to continue primary care. It is the starting point to cultivate patients' trust by providing patients with super-expected experience through targeted demand satisfaction, so as to improve patients' expectation confirmation. Taking public health services as an opportunity to establish emotional trust, relying on the improvement of diagnosis and treatment ability and the optimization of referral services to establish technical trust and service trust may be the key path to enhance the first diagnosis of patients' willingness at the grassroots level.
The health of primary and secondary school students in China faces many challenges. Against the policy background of the state strengthening physical health management and promoting family doctor contract services, it is imperative to extend family doctor contract services to functional communities such as schools.
Research on the design of family doctor contract service package suitable for the characteristics of Beijing from the perspective of grass-roots medical and health institutions and schools, and provide for promoting the work of family doctor contract service in functional communities such as schools.
Using convenient sampling method, 62 participants, including heads of family doctor teams from community healthcare services and school doctors from primary and secondary schools in seven districts of Beijing were selected for a questionnaire survey in August 2024. The survey included the basic information of the respondents, assessing the necessity of basic health service package and four types of personalized service packages (vision, nutrition, oral, and psychological), covering service necessity, implementation feasibility, and recommendation rates. The numbers of items in the basic health service package and the vision, nutrition, oral, and mental health service packages were 10, 9, 8, 9, and 7, respectively. Item evaluations for each type of health service package were calculated using the number of records, where number of records =number of service items × total number of evaluations. Recommendation rate=number of positive responses / total number of records.
The overall recommended proportions of the basic health service package and four types of personalized health service packages were 83.5% (518/620), 74.2% (414/558), 72.2% (358/496), 66.6% (372/558), and 70.0% (304/434), respectively. Among them, the recommended proportions of services such as establishing and updating health records and vaccination services, visual health education and intervention services, nutritional counseling and guidance services, establishing student oral records service items, and establishing student mental health records services were relatively high, at 93.5% (58/62), 93.5% (58/62), 91.9% (57/62), 83.8% (52/62), 83.8% (52/62), and 77.4% (48/62), respectively. The recommended proportions of services such as carrying out self-filling screening scales for psychological problem screening, discovering common eye diseases such as conjunctivitis, nutritional therapy services, root canal therapy services, appropriate technologies such as psychological relief were relatively low, at 75.8% (47/62), 56.5% (35/62), 53.2% (33/62), 53.2% (33/62), and 59.7% (37/62), respectively. Apart from the necessity and feasibility of the basic health service package, the evaluations of the family doctor contract services for primary and secondary school students showed statistically significant differences between primary healthcare institutions and school medical professionals (P<0.05).
Basic health services, as well as personalized health record management, health education and intervention, and nutrition consultation and guidance services are key contents of the family doctor contract service package for primary and secondary school students in Beijing. The diagnosis and treatment service items are also necessary, but the items should selected and included in the contract service package according to the actual diagnosis and treatment capacity of the grass-roots medical and health institutions.
There exist structural issues in China's healthcare system, where secondary and tertiary medical institutions are more likely to attract medical professionals with advanced academic degrees and high professional qualifications. Guiding the outreach of superior medical resources through a combination of administrative requirements and moderate incentives is an important measure to improve the quality of primary care services in the short term, with personnel outreach as the core priority of this initiative.
The outreach of specialists from county-level hospitals is one of the key measures to strengthen primary-level medical services. This study analyzed the potential classes of specialist outreach activities in a certain city and explored the impact of different classes on the job perception and competence of primary care providers, aiming to provide references for improving the practice of personnel downward mobility.
The study was conducted in a city of Shandong Province in October 2022, using multistage cluster sampling. First, 6 counties/county-level cities were selected; next, 6 townships/towns/subdistricts were randomly sampled from each of them, totaling 36 sites. Questionnaires were distributed to all on-duty medical staff (general practitioners, nurses, public health workers, etc.) on the day of investigation at sampled township health centers/community health service centers, plus 15 village doctors (active in family doctor teams) from each institution. Data were collected via a general information questionnaire, an evaluation of medical personnel outreach practices scale (assessing opportunities for case discussions, outpatient consultations, joint home visits, and training with higher-hospital specialists), a job satisfaction scale, and a diabetes management competence scale. Latent class analysis (LCA) identified patterns of outreach participation, and multiple linear regression examined how these latent classes affected primary staff's job satisfaction and diabetes management competence. A multi-stage cluster sampling method was used to select primary care providers in a certain city. Data were collected using a general information questionnaire, an evaluation questionnaire on personnel outreach practices, a job satisfaction scale, and a diabetes management capability scale. Latent class analysis was conducted on the participation of primary care providers in outreach activities, and multiple linear regression was used to analyze the impact of potential classes of outreach on the job satisfaction and diabetes management competence of primary medical personnel.
A total of 2 233 primary medical personnel were surveyed. Their participation in specialist downward mobility activities could be clustered into 3 potential classes: the comprehensive support group (31.66%, n=707), the in-hospital support group (16.93%, n=378), and the overall support deficiency group (51.41%, n=1 148). Results of multiple linear regression analysis showed that compared with the overall support deficiency group, both the comprehensive support group (B=4.798, P<0.001) and the in-hospital support group (B=3.241, P=0.002) positively predicted job satisfaction scores. Additionally, both the comprehensive support group (B=3.922, P<0.001) and the in-hospital support group (B=1.659, P<0.001) positively predicted diabetes management capability scores.
There are 3 potential categories of primary medical personnel's participation in specialist downward mobility activities. The richness of practical support activities varies, and more abundant support activities are positively correlated with job satisfaction and diabetes management competence. It is suggested to focus on specific and diversified support content in the downward mobility of specialists to truly improve the professional fulfillment and diabetes management competence of primary care providers.
The integration of medical care and preventive services is a key strategy in advancing the Healthy China Initiative. However, substantial divergence among stakeholders in terms of its concept, connotation, standards, and mechanisms hampers policy transformation and calls for integrated evidence.
This study aims to conduct a systematic review of the concept, connotation, pathways, content and characteristics of the integration of medical care and preventive services in China, providing evidence to inform policy design and research.
A systematic review approach was adopted. Literature published between 2018 and 2024 was retrieved from China National Knowledge Infrastructure, Wanfang Data, and the Chinese Medical Journal Network using the keywords"integration of medical care and preventive services""integration"and"connotation"from December 31, 2024. A revised analytical framework—grounded in the theories of social determinants of health and integrated care—was applied for data extraction. Data were further integrated, analyzed, and interpreted through the lens of transaction cost theory from new institutional economics.
A total of 27 studies published since 2020 were included. No universal consensus was found regarding the concept and connotation of the integration of medical care and preventive services, leading to elevated ex-ante transaction costs such as negotiation complexity. Regarding integration pathways, studies demonstrated analytical diversity but showed imbalance, with greater emphasis on clinical, normative, and system dimensions, while organizational, functional, professional, and individual dimensions were underexplored, thereby contributing to higher ex-post transaction costs during implementation. In terms of service content, discussions were comprehensive yet limited in scope, focusing mainly on preventive and medical services and their marginal extension, with insufficient attention to health management and patient empowerment services, which may result in multiple layers of transaction costs. As for integration characteristics, although various key features such as continuity, life-course orientation, comprehensiveness, and systematization were proposed, detailed analyses and interpretations were lacking, which may lead to increased transaction costs at different stages.
This study suggests that future research should strengthen the theoretical conceptualization and demand-side perspective; enhance analysis of organizational, functional, professional, and individual pathways; broaden the scope of integration to encompass preventive, medical, health management, and patient empowerment services; and provide more detailed discussions on key integration characteristics. The conceptual and connotative discussions of the integration of medical care and preventive services should strike a balance between policy design and policy implementation, between reality responsiveness and theoretical insight, and between supply-side perspectives and demand-side concerns. These insights may contribute to reducing ex-ante and ex-post transaction costs in both the design and implementation of institutional arrangements.
Family doctor contract service is a key measure to promote graded diagnosis and treatment. Team effectiveness is the core antecedent that affects the performance of family doctor teams, but the mechanism of its internal and external factors is currently unclear and needs to be empirically explored.
To conduct empirical research on the effectiveness of family doctor teams and explore the underlying mechanisms and effects of internal and external influencing factors on team effectiveness.
From March to May 2024, conducted a questionnaire survey of family doctor team members from 20 community health service centers in Shanghai's public hospital high-quality development pilot project. The questionnaire includes personal basic characteristics, team situation, team service efficiency scale, organizational support scale, and family doctor team leader leadership strength scale. The team service efficiency scale was designed by the research group and includes four sub scales: human resource allocation, ability reserve, team operation, and output execution. Single factor analysis and multiple linear regression were used to analyze the influencing factors of the scores on the output execution subscale of family doctor teams, and structural equation modeling was used to analyze the mechanism of the effects of internal and external factors on team output execution.
A total of 514 questionnaires were distributed, and 509 valid questionnaires were collected, with an effective response rate of 99.0%. The average score of the team output execution subscale is (3.99±0.76) points. The results of univariate analysis showed that there was a statistically significant difference (P<0.05) in the scores of the output execution subscale among teams with different ages and years of service as family doctors/general practitioners; There was a statistically significant difference (P<0.05) in the scores of the output execution subscale among teams with different numbers of family doctors and the ratio of family doctors to family doctor assistants; There was a statistically significant difference (P<0.05) in the scores of the output execution subscale between the teams with or without rehabilitation physicians, public health physicians, and third-party personnel. The results of multiple linear regression analysis showed that the scores of the team operation subscale, as well as the scores of organizational support and team leader leadership, had a positive impact on the scores of the team output execution subscale (P<0.05). The results of the structural equation model indicate that team operational factors, external factors, and internal structural factors all positively drive the execution of team effectiveness output (P<0.05), with decreasing degrees; There is a significant positive correlation (P<0.001) between external factors driving team operation and internal structural factors, with decreasing degrees; Internal structural factors significantly drive team operation (P<0.001).
Individual years of practice, number of doctors in the team, team personnel configuration, team capacity reserve, team operation, organizational support, and leadership of family doctor team leaders all have an impact on the output and execution level of team effectiveness; The structural and procedural elements within the team positively drive team effectiveness. It is necessary to establish and configure a family doctor team reasonably, continuously improve team capabilities, and strengthen organizational support to enhance team effectiveness.
The key and difficulty in building a compact county medical community lies in grassroots medical and health institutions. Currently, research on grassroots medical and health institutions under the compact county medical community mainly uses discontinuous time series models and DEA models to analyze their operational efficiency. There is a lack of comprehensive evaluation of the service performance of grassroots medical and health institutions from multiple dimensions, Therefore, it is of great significance to conduct research on the service performance of grassroots medical and health institutions under the tight county medical community.
Evaluate the service performance of grassroots medical and health institutions in 39 pilot counties (cities, districts) of Guangxi's tightly knit county-level medical communities, in order to provide a basis for deepening the high-quality development of Guangxi and nationwide tightly knit county-level medical communities.
Collect operational data of grassroots medical and health institutions in 39 pilot counties (cities, districts) from 2018 to 2021, and evaluate them using descriptive analysis, entropy weighted TOPSIS and RSR.
From 2018 to 2021, the Ci values of the service performance of grassroots medical and health institutions were 0.311 2, 0.363 2, 0.579 1, and 0.674 2, respectively. Ranked first in 2021 and last in 2018; In 2021, a total of 7 pilot counties (cities, districts) were evaluated as "excellent" in the service performance of grassroots medical and health institutions, accounting for 17.95%. A total of 6 individuals were rated as "poor", accounting for 15.38%. The remaining 26 were rated as "medium", accounting for 66.67%.
The sinking of resources has been improved, capacity building has been further strengthened, access to health equity has increased, the efficiency of medical insurance fund utilization has improved, and overall service performance is showing an upward trend. However, the two-way referral system needs to be strengthened, resource utilization efficiency needs to be strengthened, and the benefit sharing mechanism needs to be further improved. There are significant differences in the service performance of grassroots medical and health institutions among pilot counties (cities, districts). We need to improve and leverage the role of the county-level medical community management committee, improve the annual total budget system of the medical community, establish a comprehensive benefit distribution mechanism, and focus on supporting pilot counties (cities, districts) with relatively poor economic development.
Traditional Chinese medicine (TCM) plays a preventive healthcare role and is valuable for chronic disease management and active aging. Community health service centers (CHCs) are key places for promoting TCM preventive healthcare services, yet elderly utilization remains unsatisfactory.
To examine the factors influencing the elderly's utilization of TCM preventive healthcare services in CHCs and evaluate their importance.
A face-to-face questionnaire survey was conducted from July to September 2022 using a multi-stage stratified cluster random sampling method in a total of 12 communities of older adults in six cities selected from Zhejiang and Guangxi Provinces. The questionnaire was designed based on an integrated framework of Andersen and Social Cognitive Theory (SCT) dual models, aiming to comprehensively collect data on the utilization of TCM preventive healthcare services and their influencing factors among the elderly. A binary Logistic regression model was used to analyze the factors influencing the utilization of TCM preventive healthcare services used by older adults, and Logistic dominance analysis was applied to determine the importance of these factors.
A total of 2 081 (94.33%) valid questionnaires were retrieved, among them, only 369 (17.73%) indicated that they had participated in TCM preventive healthcare services in the past year, and the frequency of utilization was mainly concentrated in 1-2 times per year [196 cases (53.11%)]. The results of binary Logistic regression model analysis showed that: the educational level in predisposing characteristics, the situation of suffering from chronic diseases and the situation of pain/discomfort in need factors, the score of perceived service environment in enabling resources, as well as the scores of cognitive status and self-control in individual factors are the influencing factors for the utilization of primary-level traditional Chinese medicine preventive and health care services (P<0.05). Further Logistic dominance analysis showed that the weights of the importance of the influencing factors, in descending order, were: individual factors (belief and knowledge, self-regulation) > enabling resources (perceived environment) > predisposing characteristics (educational level) > need factors (chronic disease, pain, or discomfort).
Individual factors play a crucial role in the decision-making process of elderly individuals regarding the use of primary care TCM preventive healthcare services. Enhancing the health literacy and self-control abilities of the elderly, along with improving the TCM service environment in CHCs, is expected to promote the widespread adoption of TCM preventive health services among the elderly population.
